Utah’s Mike Lee became the fifth Republican senator Tuesday to oppose even beginning debate on the GOP’s foundering health care bill, tossing another hurdle in the path of party leaders who’ve hoped the Senate would approve the measure this week.

Lee was among four conservatives who announced last week that they were against the current version of the legislation. His spokesman Conn Carroll said Tuesday that Lee would not vote for the crucial vote to commence debate on the bill “as it is currently written,” a roll call that’s expected Wednesday.

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GOP defections have built after Congress’ nonpartisan budget referee said Monday that their measure would leave 22 million more people uninsured by 2026 than President Barack Obama’s law. The bill will be derailed if just three of the 52 Republican senators vote against it.

Senate Majority Leader Mitch McConnell, R-Ky., was hoping to staunch the rebellion and win Senate passage this week, before a weeklong July 4 recess that leaders worry opponents will use to weaken support for the legislation.

“I would not bet against Mitch McConnell,” his House counterpart, Speaker Paul Ryan, R-Wis., told reporters. But the Senate was convening later than usual Tuesday with no sign that debate on the health care measure would begin as leaders had hoped, underscoring McConnell’s need to focus on closed-door deal-making to rescue the bill.

The CBO analysis suggested some ammunition GOP leaders could use, saying the Senate bill would cut federal deficits by $202 billion more over the coming decade than the version the House approved in May. Senate leaders could use some of those additional savings to attract moderate votes by making Medicaid and other provisions more generous, though conservatives would rather use that money to reduce red ink.

One moderate who has criticized the measure’s Medicaid cuts, Sen. Shelley Moore Capito, R-W.Va., said she expected McConnell to discuss revisions at a Tuesday lunch of GOP senators. Capito and another moderate, Sen. Lisa Murkowski, said they were concerned about the bill but neither said they were ready to vote against debating it.

Lee and other conservatives have favored a fuller repeal of Obama’s statute than the Senate bill would enact. On Facebook last week, Lee wrote that the Senate bill “doesn’t even significantly reform American health care,” and said he’d settle for language letting states and individuals completely opt out of Obama’s law.

Minutes after the report’s release, three GOP senators threatened to oppose beginning debate.

Moderate Sen. Susan Collins, R-Maine, said she would vote no. She tweeted that she favors a bipartisan effort to fix Obama’s statute but added, “CBO analysis shows Senate bill won’t do it.”

Conservative Sen. Rand Paul, R-Ky., said he would oppose that motion unless the bill was changed. And fellow conservative Ron Johnson, R-Wis., said he had “a hard time believing” he’d have enough information to back that motion this week.

Paul tweeted that he was meeting with President Donald Trump at the White House Tuesday.

The 22 million extra uninsured Americans were just 1 million fewer than the number the budget office estimated would become uninsured under the House version.

Trump has called the House bill “mean” and prodded senators to produce a package with more “heart.”

The budget office report said the Senate bill’s coverage losses would especially affect people between ages 50 and 64, before they qualify for Medicare, and with incomes below 200 percent of poverty level, or around $30,300 for an individual.

In one example, the report says that in 2026 under Obama’s law, a 64-year-old earning $26,500 would pay premiums amounting to $1,700 a year, after subsidies. Under the Senate bill, that person would pay $6,500, partly because insurers would be able to charge older adults more.

The Senate plan would end the tax penalty that law imposes on people who don’t buy insurance, in effect erasing Obama’s so-called individual mandate, and on larger businesses that don’t offer coverage to workers.

It would let states ease Obama’s requirements that insurers cover certain specified services like substance abuse treatments, and eliminate $700 billion worth of taxes over a decade, CBO said, largely on wealthier people and medical companies that Obama’s law used to expand coverage.

It would cut Medicaid, which provides health insurance to over 70 million poor and disabled people, by $772 billion through 2026 by capping its overall spending and phasing out Obama’s expansion of the program. Of the 22 million people losing health coverage, 15 million would be Medicaid recipients.

CBO said that under the bill, most insurance markets around the country would be stable before 2020. It said that similar to the House bill, average premiums around the country would be higher over the next two years — including about 20 percent higher in 2018 than under Obama’s statute — but lower beginning in 2020.

The office said that overall, the Senate legislation would increase out of pocket costs for deductibles and copayments. That’s because standard policies would be skimpier than currently offered under Obama’s law, covering a smaller share of expected medical costs.

Meanwhile, an analysis of premiums under the Senate bill by the nonpartisan Kaiser Family Foundation found more bad news for Republicans. Net premiums for midlevel silver plans that most consumers now buy would go up 74 percent on average under the Senate bill, from $197 a month to $342. States that were critical to Trump’s election victory would see sharp increases, even after subsidies, including Ohio, Pennsylvania, Florida, Wisconsin and Michigan.___Associated Press writers Erica Werner, Ricardo Alonso-Zaldivar, Ken Thomas, Andrew Taylor and Michael Biesecker contributed to this report.